Search

There is limited knowledge about masticatory function after the release of temporomandibular joint (TMJ) ankylosis. In this study, masticatory function was evaluated by measuring maximum voluntary bite force (MVBF) and chewing efficiency in 30 unilateral TMJ ankylosis patients who were treated with buccal fat pad (BFP) interpositional arthroplasty. Eighteen subjects over 12 years of age were included in study Group A and 12 subjects below 12 years of age in study Group B. Patients in the study groups had completed a minimum follow up of one year after surgery. Control groups C (over 12 years of age, n = 18) and D (under 12 years of age, n = 12) consisted of age, sex, and weight-matched normal subjects. The mean MVBF was measured between occluding molar teeth with a strain gauge transducer. Chewing efficiency was measured with two different coloured chewing gum strips. These were chewed for 5, 10, 20, 30, and 50 strokes. Compared with normal subjects, the study groups (A and B) could generate 64.7% (p = 0.004*) and 89.8% (p = 0.121) of MVBF, respectively. Overall chewing efficiency was 88.7% in Group A and 92.9% in Group B (p = 0.014* and p = 0.138, respectively) when compared with normal subjects. The study has shown that BFP interpositional arthroplasty effectively restores masticatory function.

A systematic review was performed to assess the clinical outcomes of the reconstructive methods using autogenous grafts for the management of temporomandibular joint (TMJ) ankylosis A comprehensive electronic and manual search of the literature without date or language restriction was performed in January 2021 to identify randomized controlled trials, prospective, and retrospective studies with the aim of comparing the various surgical modalities for TMJ ankylosis. Twenty-six publications were included: prospective (n ​= ​17), retrospective (n ​= ​7), randomised control trial (n ​= ​1) and ambispective study (n ​= ​1). Costochondral graft was the most common graft used followed by Coronoid process graft. Meta-analysis was not possible as most of studies were non-controlled in nature. Based on the available data, there was a strong evidence that autogenous grafts especially Costochondral grafts and coronoid grafts have remained one of the most favoured methods of reconstruction. Prospective and randomized control studies are recommended for the best stratification for the use of autogenous grafts for the management of TMJ ankylosis.

Extrahepatic portal venous obstruction (EHPVO) and temporomandibular joint (TMJ) ankylosisis are significant problems in Asian countries. Both EHPVO and bilateral TMJ ankylosis may have rare association due to protein C and S deficiency which may cause hypercoagulability as well as reduced fibrinolytic activity. Ankylosis arising in early childhood is associated with facial asymmetry, feeding difficulty and speech development alterations. It is also associated with great challenges of endoscopic management in extra hepatic portal vein obstruction (EHPVO) with variceal bleed as well as air way management during surgical management and post-operative recovery. Recently a case series had shown association of TMJ ankylosis with EHPVO due to protein C deficiency which might be an etiological factor for both EHPVO as well as TMJ ankylosis. This case report documents a case of 14 year young girl who had TMJ ankylosis due to ear infection and EHPVO with esophageal varices had multiple episodes of upper GI bleed with mild deficiency of protein C and S, successfully managed with proximal splenorenal shunt to prevent further episodes of upper GI bleed, as endoscopic management is not feasible due to TMJ ankylosis.

This article reports a unique case of superolateral dislocation having a posterior component also, causing severe mandibular retrognathia (bird face deformity) and airway compression (asphyxia). Contemporary literature was also reviewed extensively, and it was found that no such type of case has been reported until date. The article also reviews etiology, causative mechanism of injury, clinical features, diagnosis and treatment planning of superolateral dislocations.

AIMS AND OBJECTIVES: Dermis fat graft has shown good clinical results as an interpositional material in temporomandibular joint (TMJ) ankylosis and prevents heterogeneous calcification following gap arthroplasty. However, survival of the graft and volume retention is still debatable. The main purpose of our study was to assess the viability of the graft, tissues changes associated with the graft and volume retention using magnetic resonance imaging (MRI). MATERIALS AND METHODS: Fifteen patients with TMJ ankylosis underwent gap arthroplasty followed by placement of abdominal dermis fat graft and were randomly divided into two groups. Group 1 was subjected to MRI analysis of the graft at 3–6 months and Group 2 was analyzed at 1–2 years post-operatively. The graft was evaluated using T1- and T2-weighed images along with fat suppression (FS) sequences in all the three planes and the volume was also calculated. RESULTS: Both Group 1 (7 patients and 11 joints) and Group 2 (8 patients and 13 joints) showed the presence of viable fat on T1 and T2 images, confirmed by FS images. Minor tissue changes were observed at the center of the graft in 5 patients of Group 1 and 3 patients of Group 2. Average volume of the graft was 4.154 cm(3) at 3–6 months and 4.269 cm(3) at 1–2 years, respectively, and when compared to the original volume of the graft (4.583 cm(3) in Group 1 and 4.712 cm(3) in Group 2), the difference was statistically insignificant (p > 0.005). CONCLUSION: MRI shows long-term survival of autogenous dermis fat graft without significant volumetric reduction. This along with positive clinical results make dermis fat an excellent choice as an interpositional material for TMJ ankylosis.

Radiotherapy at the temporomandibular joint (TMJ) area often results in trismus, however, post radiation ankylosis is extremely rare and has not been previously reported in literature. Radiation is known to impact the vasculature of bony structures leading to bone necrosis with certain risk factors including surgical intervention, even teeth extraction, that could lead to osteoradionecrosis. Accordingly, gap arthroplasty for such case seemed rather challenging. In this report, we introduce for the first time, a rare case of temporomandibular joint ankylosis post radiotherapy for management of rhabdomyosarcoma in a 12 years-old boy. A modified gap arthroplasty technique combined simultaneously with pterygo-masseteric muscle flap was applied to lower the risk of osteoradionecrosis due surgical trauma at irradiated area. Computed tomographic scan on the head indicated that the TMJ architecture was completely replaced by bone, with fusion of the condyle, sigmoid notch, and coronoid process to the zygomatic arch and glenoid fossa. The patient’s problem was totally solved with no osteoradionecrosis or relapse of ankylosis observed at follow up visits. Herein, the modified gap arthroplasty combined with pterygo-masseteric muscle flap could be recommended to be applied on other cases of ankylosis especially after receiving radiotherapy.

Temporomandibular joint (TMJ) ankylosis is a rare and a debilitating condition. The major etiological factor is trauma in young age. This is due to greater potential of growth when compared with adults. The management of TMJ ankylosis is challenging due to the high incidence of recurrence and to the absence of a published consensus. We presented a long-term follow-up for a rare case of recurrent TMJ ankylosis post childhood trauma. Patient underwent multiple surgeries with autologous reconstruction, interposition arthroplasty, and coronoidectomy. Finally and after the development of skull base ankylosis, patient was treated with alloplastic reconstruction at adulthood. She was then followed up for 10 years post-op with excellent mouth opening. Thus, the treatment of recurrent TMJ ankylosis in children is still controversial with a debate about the applicability of TMJ prosthesis to prevent multiple procedures.

Introduction: Temporomandibular joint (TMJ) is a structurally complex joint. TMJ deficiency and deformity can result from different causes. Ankylosis of the TMJ is considered the most common cause leading to severe form of deformity and shortening of the ramus / condyle unit which can affect both, function and esthetic and is difficult to treat. Different surgical procedures have been used to treat this deficiency, with variable degrees of success rates. Distraction osteogenesis is a well-established technique that is used to treat different maxillofacial deformities. A recent use in reconstruction of the deficiency or ramus-condyle unit is developed Aim: The objective of this study was to evaluate the use of transport distraction osteogenesis in restoring the deficient condyle/ramus unit of patients with unilateral or bilateral TMJ ankylosis to correct the resultant deformity. Materials and Methods: Ten patients with TMJ ankylosis underwent Transport condylar ramus distraction osteogenesis to reconstruct the condyle after release and gap arthroplasty. The distractors used were extraoral submerged ones. Results: Five males and five females were included. Their age ranged from 2 to 46 years with an average of 21.2years. The follow-up period ranged from 15 to 60 months with an average of 30.2 months. Successful treatment was achieved in seven cases. Complications were mild in two, moderate in four and severe in three. Conclusions: Transport condylar distraction osteogenesis is a valuable treatment option for TMJ ankylosis. It has a considerable complication rate that must be considered its choice and discussed thoroughly with the patient/guardian.

Temporomandibular joint ankylosis (TMJ) is a condition affecting mastication, speech, appearance, and oral hygiene to a major extent. The disease is manifested by restriction to complete failure of the TMJ movement due to fibrous or bony union between the condylar head and glenoid fossa. This case report describes a case of a 13-year-old girl with inability to open the mouth along with fractured and discolored anterior teeth due to trauma. Patient was diagnosed as unilateral bony TMJ ankylosis left side and managed by surgical procedure interpositional arthroplasty followed by physiotherapy. Following satisfactory mouth opening, the required dental rehabilitation procedures were done. Combined efforts of pediatric dentists and oral and maxillofacial surgeon with a detailed history, clinical and radiographic assessment helps in correct diagnosis and providing immediate surgical intervention along with the management of associated dental complications in order to reestablish physical and psychological health of the child patient. How to cite this article Patidar D, Fry RR, Sogi S, et al. Dental Rehabilitation Following Surgical Management of Temporomandibular Joint Ankylosis: An Interdisciplinary Approach. Int J Clin Pediatr Dent 2020;13(2):203–205.

Temporomandibular joint ankylosis (TMJa) is a debilitating condition that causes difficulty in mastication, speech and mouth opening. Its treatment poses surgical and rehabilitative challenges along with a high incidence of reankylosis. This study was designed to assess the long-term outcomes with a new two phase physiotherapy protocol following conservative resection of the ankylotic mass.143 patients who were treated for TMJa were initially recruited, among whom 98 were inducted into the study and retrospectively evaluated using clinical records and 3-dimensional computed tomography. All the patients underwent a minimal pre auricular incision and conservative interpositional gap arthroplasty with collagen membrane. This was followed by the new two phase physiotherapy protocol with the use of a bite block. The primary outcome measures were the maximum interincisal distance, vertical ramus height and complications. The patients were followed up at monthly intervals during the first year, quarterly intervals during the second year, and at intervals of 6 months during subsequent follow-up years. The mean follow up period was 6.38 ± 2.36 years after ankylotic release. Paired student t test was used for statistical analysis.The mean scores for mouth opening at T1, T2 and T3 were statistically significantly different at all intervals (p 0.0005). The mean scores for ramal length were statistically significantly different at T1 and T2 interval (p 0.0005) and insignificant at T2 and T3 interval. No reankylosis was observed in patients who followed the physiotherapy protocol.In the management of TMJa, the success of the conservative surgical technique with interpositional arthroplasty is less dependent on the longevity and rigidity of the interpositional material but more indebted to the patient compliance in following the proposed physiotherapy protocol.

Highlights • Ankylosis in children can affect growth, function, esthetic. • Un observed or missed facial trauma in children can end with serious complication. • Re-ankylosis is convoluted bothersome complication should kept in mind. • Mouth opening should be at maximum range by the end of surgery. • Patient follow up is mandatory for a period of time., Introduction The clinical importance of ankylosis in children is concerning with its massive effect and disturbance on the mandibular future growth causing gross deformity apart from the limited mouth opening. Trauma is the most common cause of bony and fibrous ankylosis. History, physical examination and radiographical examination of each patient with ankylosis of TMJ is mandatory in arriving to a final diagnosis, severity, involvement of adjacent structures and ultimately to plan the treatment. Case presentation Ten years old girl presented with her family seeking solution for a severely limited mouth opening. From the history, the child has suffered from height fall at the age of 4 years. She had complained from swelling and pain near the ear, treated by analgesics, gradually subsided and neglected. This limitation affects on feeding and had an impact on the child's health, seeking for management for the condition became mandatory. Clinical examination, radiographical examination is prepared in beside that ethical approval with full discussion with the parents done. Blind nasal intubation done. Discussion Patients with true bilateral ankylosis are considered as the aggressive type. It’s not just because of ankylosis. Surgeons should keep in their minds that well experienced anesthetist is important; also extension of the ankylosed bone with amount of cutting is important and re ankylosis as a complication must be avoided. Conclusion The surgeons agree with the statement that success in the preventing reankylosis after TMJ gap arthroplasty. Its primarily refers to the early postoperative physiotherapy, maintained on a long term.

Background Temporomandibular joint ankylosis is a distressing condition which leads to significant functional debility and facial blemish. It can be surgically managed with gap or interposition arthroplasty, with an objective to restore joint function and prevent re-ankylosis. Sometimes TMJ ankylosis can present with atypical presentations like skull base ankylosis. The main aim of this surgery is to successfully treat such conditions efficiently without any possible complications. However, surgical procedures for such atypical presentations in this disease are rarely reported. Case summary Here we report a 27 year old male with Left TMJ ankylosis involving the skull base. The patient presented with reduced mouth opening with a previous history of trauma. For treatment we performed a surgery by doing osteoarthrectomy with interpositional arthroplasty of left TMJ using piezosurgery. To our knowledge this is the only TMJ ankylosis case with involvement of bones of the skull base treated with piezosurgery. Intraoperatively we achieved a mouth opening of 30 mm, and postoperatively after 15 days mouth opening up to 30 mm was achived with physiotherapy. Conclusion Some times TMJ ankylosis can present with atypical presentations in which bones of the skull base are involved. These are very rare and could be termed as ‘skull base ankylosis’. Such cases can be surgically challenging and some surgical treatment modalities like Computer Assisted Surgery (CAS), 3D Navigation and Piezo-electric surgery could be beneficial in avoiding complications and facilitating efficient treatment.

Introduction We discuss our findings on the retention of the medially displaced residual condyle during the treatment of type III temporomandibular joint ankylosis, as well as the postoperative results observed during follow-up. Materials and methods Thirty-two patients with type III temporomandibular joint ankylosis that met the inclusion criteria of the study were included as subjects. The morphological integrity of the medially displaced residual condyle was verified in all of the participating patients through the use of cone beam computed tomography. The duration of the ankylosis ranged from 2 to 12 years. The maximum length that patients were able to open their mouths ranged from 6 mm to 14 mm. The surgical treatments used in this report included the separation of bony fusions between the condyle and the glenoid fossa, resection of the ankylosed sites, preservation of the displaced condyles in their medial position and suturing the remains of the disc to its typical position or taking the temporalis myofascial flap instead. The long-term results were evaluated by computed tomography and clinical follow-up examinations. Results Three-year postoperative follow-up examinations were performed for all of the patients included in this study. No recurrences were observed in the patients who adhered to the postoperative therapeutic advice. Patients had an average maximal mouth opening distance of 34.50 ± 5.75 mm as recorded during the final follow-up examination. Conclusions The released medially residual condyle can still function normally in temporomandibular joint movement and without reankylosis after a bone fusion resection. The displaced condyle should thus be preserved instead of being removed during the treatment of type III temporomandibular joint ankylosis.

INTRODUCTION: A plethora of surgical options have been described in the literature for the management of temporomandibular joint (TMJ) ankylosis, but one cannot subscribe to a modality that is infallible in regard to recurrence. The incidence of recurrence is attributed to poor surgical technique and poor patient compliance. This article proposes incorporation of subtle modifications into the surgical techniques that could prove to be helpful in the management and prevention of reankylosis. MATERIALS AND METHODS: Twenty-one patients with TMJ ankylosis with an age range of 10–29 years (mean age 19 years) were operated, of whom six (28.5%) were bilateral and 15 unilateral (71.5%), and 14 (66.6%) had a history of previous surgery for ankylosis. The preoperative and intraoperative mean inter-incisal opening (MIO) was 4.4 mm and 43.2 mm, respectively. All patients fared well at the late postoperative evaluation at 24 months with a mean MIO of 36.9 mm. CONCLUSION: The subtle modifications address various aspects such as the adequacy of the preauricular approach, the use of a wide flame-shaped bur, the obliquity of the arthroplastic osteotomy, burnishing the residual ramal stump devoid of irrigation, temporalis muscle release and coronoidectomy, aggressive intermittent intraoperative jaw physiotherapy, mandatory use of a vacuum drain and rigorous postoperative jaw physiotherapy.

The purpose of this study is to evaluate the role of primary osteo-distraction prior to ankylosis release in patients, diagnosed with sleep apnoea, facial asymmetry, and reduced quality of life secondary to temporomandibular joint (TMJ) ankylosis.Ten patients in the age group of 13-40 years with TMJ ankylosis underwent primary osteo-distraction for mandibular advancement. They were evaluated pre- and post-operatively using radiographs, various questionnaires, and subjective evaluation of facial asymmetry, sleep apnoea, and quality of life (QOL).All the ten patients showed significant improvement in their sleep apnoea symptoms with a mean of 6.20 ± 1.39 (P 0.05). The mean advancement of the mandible in all the ten patients (both bilateral and unilateral ankylosis) was 15.8 mm (P 0.05). The quality of life showed marked improvement from very poor to very satisfactory (P 0.001).Primary mandibular distraction is an effective method of correction of facial asymmetry, sleep apnoea, and quality of life in patients with TMJ ankylosis.

Introduction While surgical interventions for temporomandibular joint (TMJ) ankylosis are well-documented, there is lack of consensus regarding the ideal approach in pediatric patients. Surgical interventions include gap arthroplasty, interpositional arthroplasty, or total joint reconstruction. Methods A systematic review of PubMed (Jan 1, 1990-Jan 1, 2017) and Scopus (Jan 1, 1990-Jan 1, 2017) was performed and included studies in English with at least one patient under the age of 18 diagnosed with TMJ ankylosis who underwent surgical correction. Primary outcomes of interest included surgical modality, preoperative maximum interincisal opening (MIO) (MIOpreop), postoperative MIO (MIOpostop), ΔMIO (ΔMIO = MIOpostop - MIOpreop), and complications. Results Twenty-four case series/reports with 176 patients and 227 joints were included. By independent sample t tests MIOpostop (mm) was greater for gap arthroplasty (30.18) compared to reconstruction (27.47) (t = 4.9, P = 0.043), interpositional arthroplasty (32.87) compared to reconstruction (t = 3.25, P = 0.002), but not for gap compared to interpositional (t = -1.9, P = 0.054). ΔMIO (mm) was greater for gap arthroplasty (28.67) compared to reconstruction (22.24) (t = 4.2, P = 0.001), interpositional arthroplasty (28.33) compared to reconstruction (t = 3.27, P = 0.002), but not for interpositional compared to gap (t = 0.29, P = 0.33). Weighted-average follow-up time was 28.37 months (N = 164). 4 of 176 (2.27%) patients reported development of re-ankylosis. There was no significant difference in occurrence of re-ankylosis between interventions. Conclusions Given the technical ease of gap arthroplasty and nonsignificant differences in ΔMIO, MIOpostop, or occurrence of re-ankylosis between gap and interpositional arthroplasty, gap arthroplasty should be considered for primary ankylosis repair in pediatric patients, with emphasis on postoperative physiotherapy to prevent recurrent-ankylosis.

Ankylosis is one of the challenging disorders of the TMJ especially in children. Trauma, infection, and systemic diseases are the most common causes, factors common to occur in children in Upper Egypt. Unfortunately, TMJ ankylosis responds only to surgical intervention. The aim of this study was to evaluate a conservative surgical approach. Materials and Methods: In this study inclusion criteria were set and 11 children suffering from ankylosis enrolled for the most conservative gap arthroplasty without interpositioning material and with postoperative physiotherapy protocol. The patients were evaluated clinically and radiographically for 24 months postoperatively regarding mouth opening and recurrence. Results: trauma was the main etiologic factor and bony ankylosis accounted for 81%, the mean gain in mouth opening was 29mm with no reported recurrence. Conclusion: using conservative gap arthroplasty in children is a success option within the justified inclusion criteria.

Introduction: The retroauricular approach (RA) has been developed in order to expose the temporomandibular joint in a way that minimizes the risk of injury to the facial nerve and masks the postoperative scar. One of its characteristics is an excellent posterolateral view of the mandibular head, which allows for the preservation of the lateral temporomandibular joint ligaments in the course of open intracapsular surgery. Aim: The aim of this study is to systematically review the currently used variants and modifications of RA. Materials and Methods: The construction of the following study is based on PICOS and PRISMA protocols. A systematic literature search was performed based on the PubMed and BASE search engines; furthermore the authors performed a more detailed search in the Google Scholar article database as well as a loop search within the references of papers included in the systematic review. Results: Searching medical articles databases, Google Scholar, and references yielded a total of 85 records. First the titles and abstracts were blindly screened which was followed by a full-text eligibility check resulting in eventually including and qualifying 7 articles for detailed analysis. Discussion: All known variants and modifications of RA are characterized by high safety for the facial nerve and an aesthetically hidden scar. There were no reports of auricle necrosis in the collected material. Conclusions: In this systematic review, 2 variants and 2 modifications of RA that allow for open temporomandibular joint surgery have been identified; all of them together cover a large spectrum of indications for joint surgery, including reposition and osteosynthesis of mandibular head fractures, eminoplasty, or eminectomy and treatment of some forms of ankylosis.

The purpose of this chapter is to inculcate a newer, deeper understanding of TMJ Ankylosis– both from the pathological as well as the clinical view point. Newer classifications may now determine surgical procedures. Interpositional materials may not be just soft tissues interposed between the cut ends, but also hard tissues forming the new Ramus Condyle Unit (RCU). Facial deformity may be recognized to be as important as inability to open the mouth; more so, if accompanied by Obstructive sleep apnea (OSA). Multi-staged treatment plans of release first followed by asymmetry correction may be replaced by single staged joint replacement & total facial aesthetic as well as functional rehabilitation. Finally, the importance of unfavorable events in TMJ Ankylosis surgery may be recognized, which would lead to better results in terms of treatment goals, i.e. to restore joint function, improve facial appearance & airway issues, correct malocclusion & re-establish harmony between the TMJ, the face and the teeth.

The Temporomandibular Joint (TMJ) is a unique joint because both the right and left joints must open synchronously for function, Ankylosis of the TMJ refers to bony or fibrous adhesion of the anatomical components of the joint and their ensuing loss of function. Early presentation means that the patient will require a less extensive surgical treatment. The reality, however, is that many patients present to the surgeons, years or decades after the initial injury, and so TMJ ankylosis would have been fully established. Causes of TMJ ankylosis include trauma and infections. Surgery with aggressive post-operative physiotherapy is the mainstay of management. There is paucity of reports on the presentation and management of this condition from our centre. We present two patients, 16 and 20 years old, with TMJ ankylosis in our centre. Both of them presented after 12 and 18 years, respectively, of initial injury to the TMJs.

A 10 year old male patient reported with a chief complaint of inability to open mouth since 4 years. There was a history of fall from height, following which there was progressive limitation in mouth opening and jaw movements. Clinically there was maximal mouth opening (MMO) of 1–2 mm with restricted protrusive and laterotrusive jaw movements. On radiographic evaluation, there was a bifid condyle appearance which showed a medially displaced condyle along with complete lateral fusion of joint components bilaterally. With a diagnosis of Sawhney’s type III ankylosis, lateral arthroplasty was planned under G.A. for both sides. On 2 years follow-up MMO of 30–34 mm was maintained along with unrestricted protrusive and bilateral laterotrusive movements. In this case, we show that the comparatively less invasive treatment plan of lateral arthroplasty involving preservation of medial condylar stump is adequate for the return of TMJ movements to near normalcy.

Introduction: Temporomandibular joint ankylosis is a debilitating condition leading to problems in mastication, speech, digestion, oral hygiene and even facial appearance. The basic techniques for surgical correction of ankylosis include the gap arthroplasty, joint reconstruction or interpositional arthroplasty. The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. Material and Methods: 21 patients of temporomandibular joint ankylosis admitted from 2015 to 2018 in the Department of Plastic Surgery, SMS Hospital, Jaipur. . Diagnosis was based on history and clinical assessment supplemented with orthopantomogram (OPG) and computer tomographic scans. Mouth opening is measured as interincisoral distance using a scale. Intraoperatively, silicon sheet is sutured with the distal part of flap using non absorbable suture in half overlapped fashion with an overlapped portion across the joint space. Preoperative photograph is taken in all patients and serial post operative photograph were taken during their regular follow up Results: 21 patients were part of the study (14 males and 7 females). 16 of our patients were post traumatic. Their age ranged from 7 to 55 years. The disease was unilateral in 19 cases and bilateral in 2 cases. The pre-op interincisal mouth opening ranged from 0 to 9 mm. The intra-operative interincisal mouth opening ranged from 28 to 46 mm. There was no immediate complication and no incidence of facial nerve injury. One patient with bilateral congenital TMJ ankylosis had recurrence. Five patients were lost after the initial 1-year follow-up. Conclusion: Use of combined temporoparietal fascia with thin silicon sheet as interpositional arthroplasty provides extra protection in cases of TMJ ankylosis and thereby decreasing the incidence of its recurrence Keyword: Ankylosis, TMJ, Interpositional arthroplasty

Background: The management of patients with a triad of temporomandibular joint (TMJ) ankylosis, retrognathia, and obstructive sleep apnea (OSA) has long been a matter of debate. Even though consensus favors distraction osteogenesis (DO) in the 1st phase of treatment to relieve the OSA, various treatment approaches for TMJ reconstruction after ankylosis release have been put forth. Most of the reconstructive modality has been focused on autogenous materials or customized TMJ prostheses after mandibular distraction.Case Presentation: The authors present a case of a patient with the triad of TMJ ankylosis, retrognathia, and OSA who underwent DO for correction of his OSA. This was followed by bilateral TMJ reconstruction with stock alloplastic prostheses on the distracted mandible, along with genioplasty to correct retrogenia.Conclusion: In this case, stock TMJ total joint prostheses were used successfully to treat bilateral TMJ ankylosis following previous surgery for mandibular distraction.

The aim of our study was to evaluate the success of distraction osteogenesis in temporomandibular joint (TMJ) ankylosis patients with facial deformities at our maxillofacial unit; assess the psychosocial and well-being outcomes of distraction osteogenesis and its impact on oral health; and discriminate the differences in quality of life (QoL) with application of external or internal devices, unilateral or bilateral, linear or multivector, and maxillomandibular or mandibular distraction.QoL and the Oral Health Impact Profile (OHIP) were prospectively studied in 42 consecutive patients with facial deformities, planned for maxillofacial distraction osteogenesis, using 2 validated questionnaires, the Orthognathic Quality of Life Questionnaire and OHIP-14. Patients who had undergone any previous surgeries were excluded.Among these patients, 16 were female, 26 male; mean age was 14.98 ± 4.88 years, and all had prearthroplastic distraction. The shortening in the mandible was in the proportion 29:01:12 in the body, ramus, and ramus-body, respectively. Mean QoL scores before and after distraction were 68.52 ± 9.50 and 26.62 ± 3.51; and mean OHIP scores before and after distraction were 33.88 ± 6.26 and 15.36 ± 2.54, a highly significant difference (P.001) suggesting improvement. Significant improvement was identified on all QoL and OHIP questions after distraction (P.01). The postdistraction overall mean QoL score among patients with extraoral or intraoral distractor did not have a significant difference (P = .32), but facial appearance in the bilateral distraction group; jaw function and overall well-being in the multivector distraction group; and facial appearance, jaw function, and overall well-being in maxillomandibular distraction group had significant improvements (P.05).Distraction osteogenesis considerably improves oral health and health-related QoL in patients with TMJ ankylosis with facial deformities. The use of an external or internal distractor did not make any difference in the QoL; however, bilateral distraction, multivector distraction, and maxillomandibular distraction resulted in better QoL outcomes.

The objective of the study was to compare the deep subfascial approach to subfascial approach in terms of facial nerve injury and quality of life.A randomized study was performed from August 2013 to March 2017 on 24 patients with unilateral TMJ ankylosis. The subjects were randomly allotted to either Group I (12, Deep Subfascial) or Group II (12, Subfascial). All patients were evaluated objectively for facial nerve injury post-operatively and subjectively for quality of life in the form of a questionnaire post-operatively for 6 months. The data were analyzed using simple descriptive statistics, mean standard deviation, Wilcoxon paired t test, Friedman's test, and Mann Whitney U test.The comparison of the difference between the groups for postoperative facial nerve function at various time intervals did not give any significant differences (p 0.05). In terms of quality of life there was a significant difference at 1 month post-operatively (p 0.05) amidst the two approaches, however, 6-month follow-up revealed that there is no significant difference between the two approaches (p 0.05).The study reveals that both the approaches are safe in terms of facial nerve injury and quality of life long term.

This case report describe the management of a 17 years old female patient having class II div 1 malocclusion with history of temporomandibular joint surgery. Intraoral examination revealed that patient have proclined maxillary incisors, exaggerated lower curve of spee, and moderate crowding in upper and lower jaw. Other complaints are bite problem, inability to grinding food and unaesthetic smile. After extraction of upper 1st premolars, canine retraction was done which was followed by retraction of severely proclined upper anterior teeth by third order bend in rectangular stainless steel arch wire. For anchorage management TPA, intra oral anchorage with tip back & toe in bends in stainless steel arch wire was satisfactory. Following treatment, marked improvement in patient’s smile, facial profile and lip competence were achieved and there was a remarkable increase in the patient’s confidence and quality of life.Ban J Orthod & Dentofac Orthop, April 2014; Vol-4 (1-2), P.31-34

Purpose The aim of this clinical study was to prospectively measure the incremental changes in the maximum interincisal opening (MIO) after 1 cm gap arthroplasty, compare these changes between unilateral and bilateral cases, and emphasize the importance of the monitoring of the MIO for at least 24 months. Materials and methods This prospective study enrolled 26 patients with TMJ ankylosis either unilateral or bilateral. The fingers assessment method was used to measure the MIO preoperatively, intraoperatively, and monthly postoperatively up to 24 months. All the patients had undergone 1 cm gap arthroplasty to release the ankylosis. The changes in MIO measurements of unilateral and bilateral cases were statistically compared. The physiotherapy was performed until the measurements had normal stable values. Results All the cases showed a significant decrease in MIO at the first three months. At 6 months, the MIO continuously increased up to 1 year. There was no difference between the unilateral and bilateral cases. At the end of the follow-up, all measurements showed normal stable values. Conclusion The monitoring of MIO is important to detect the early signs of re-ankylosis. It is the only way that can be used in which the early signs cannot be detected in radiographs.

BACKGROUND: Ankylosis of the temporomandibular joint (TMJ) is a pathological disorder which results in patients’ limited or even complete failure of mouth opening. When TMJ ankylosis occurs during the growing age, moderate to severe micrognathia might be the proposed scenario of such cases, accompanied by obstructive sleep apnea and hypopnea syndrome (OSAHS). TMJ reconstruction using total TMJ prostheses with mandibular advancement (MA) can simultaneously improve the function and aesthetic profile of such patients. The purpose of this study was to determine whether the upper airway can be improved after TMJ reconstruction with total TMJ prostheses combined with or without MA in TMJ ankylosis patients. METHODS: Fourteen patients with pre-(T1) and post-(T2) operative CT scans were included. Patients were divided into two groups according to the operation with or without MA (MA/WoMA). The changes of the upper airway and jaw bones were comparatively analyzed within and between the two groups. RESULTS: In MA Group, the volume of the total upper airway (Vt) and palatopharynx (V1), together with the surface area (SA) of the total upper airway (SAt) and palatopharynx (SA1) increased significantly after the operation by 41.4%, 43.2%, 36.3% and 36.6%, respectively. In WoMA Group, V1, SAt and SA1 increased significantly by 21.0%, 19.0% and 23.1% following surgery. The changes of Point B (P

Aim: This study aimed to evaluate temporomandibular joint reconstruction in Yemeni children with metatarsal bone graft after release of ankylosis. Methodology: Ten patients ≤12 years of age, comprising eight unilateral and two bilaterally TMJ ankylosis, were selected for this study. These patients underwent reconstruction with 10 non-vascularized metatarsal grafts. The reconstructed joints were then followed for an average of 1 year. Measures of opening, symmetry, and clinical symptoms relating to the reconstructed joints were assessed. Results: Mean pre-operative interincisal aperture was 8.2mm, and immediate post-operative aperture 23.4mm. At the end of the follow-up period, acceptable results were achieved in 8 out of 10 cases, with adequate mouth opening of 35.6mm in 8 out of 10 patients and overall interincisal aperture of 30.3mm. Re-ankylosis occurred in two bilaterally-treated patients at the end of follow-up. Subjectively, 80% of the patients rated their function as satisfactory and were able to occlude and masticate without any difficulty. Conclusion: Reconstruction of TMJ after release of ankylosis utilizing metatarsal bone graft shows a satisfactory interincisal aperture in 80% of patients.

Distraction osteogenesis (DO) has been one of the most innovative concepts in cranio-maxillofacial syndromology and surgery over the last 25 years.Early mandibular distraction in severe micrognathia has recently been recognized as an effective treatment option to safely relieve upper airway obstruction associated with mandibular deficiency.An increased incidence in temporomandibular joint complications during DO in neonates has recently been reported, especially in syndromic patients.The authors report 2 children affected by severe micrognathia and severe respiratory distress at birth.Early DO was performed during the first 2 months of the life in another institution with the aim of increasing mandibular length and upper airway size.Both the patients had severe restricted jaw opening after DO and mandibular abnormalities.Temporomandibular joint ankylosis after early mandibular distraction could be a considered a new pathological entity.

Management of condylar head fractures (CHF) of the temporomandibular joint (TMJ) remains a source of controversy. Based on established literature, group of CHFs and conservative treatment connected with period of maxillomandibular fixation (MMF) increases the risk for TMJ ankylosis. This paper presents anatomical and functional results of surgical treatment of condylar head fractures in a group of 24 patients (29 joints). Fractures were diagnosed based on conventional radiographs and computed tomography (CT) scans. Utilising an intraoperative arthroscopy authors evaluated actual intraarticular posttraumatic changes. This study presents acceptable functional and radiological results of surgical treatment of condylar head fractures with more than 3-year follow-up. The authors believe that re-establishing the pretraumatic anatomic position of the TMJ components (fragment and the disc) and early postoperative rehabilitation are inevitable to minimize the risk of postraumatic TMJ ankylosis (Tab. 2, Fig. 8, Ref. 31).

This study aimed to describe the clinical features of different types of traumatic temporomandibular joint (TMJ) ankylosis. Seventy-one patients with 102 ankylosed joints were retrospectively reviewed and categorized into four groups according to the grades of severity: type I, non-bony ankylosis of the joint with almost-normal joint space; type II, lateral bony ankylosis marked by a normal joint space that coexists with a radiolucent line; type III, complete bony ankylosis of the joint characterized by only a radiolucent line; and type IV, extensive bony ankylosis without any radiolucent line. The period of ankylosis, maximal mouth opening (MMO), rate of complications, and histopathological changes were compared among groups. Intergroup comparison showed significant differences in the clinical features of MMO and the incidence of complications (p

espanolIntroduccion: Presentamos nuestra experiencia y serie de casos en los que se ha utilizado la protesis de ATM disenada y desarrollada en Espana por el Dr. Carlos Goizueta (Hospital Sant Joan d'Alacant) junto con el Instituto Tecnologico de Canarias y Maxilaria. Materiales y metodos: Pacientes tratados con patologia de la articulacion temporomandibular y que han sido reconstruidos con una protesis de ATM. Esta protesis tiene cuatro componentes, dos de la fosa articular (una parte de titanio y la otra de polietileno) y dos del cuerpo de la protesis (cabeza de cromo-cobalto y rama de titanio). Resultados: Se presentan los resultados preliminares de los pacientes reconstruidos con protesis de ATM en los ultimos 2 anos en nuestro centro. Se han colocado un total de 8 protesis en 6 pacientes. El diagnostico de los pacientes fue anquilosis en 4 de los casos, y disfuncion ATM avanzada en los otros 2. Se vio una mejoria, tanto del dolor como de la apertura oral, en un seguimiento minimo de 6 meses. Conclusion: Esta protesis de ATM, de desarrollo nacional, tiene varias ventajas como son la posibilidad de recambio de algun componente y tambien el diseno del mismo hace que las fuerzas masticatorias se transmiten a la rama mandibular y no a los tornillos de la protesis. EnglishIntroduction: We present our experience and case series in which we used a TMJ prosthesis designed and developed in Spain by Dr. Carlos Goizueta (Hospital Sant Joan d'Alacant), together with the Technological Institute of Canarias and Maxilaria Materials and methods: Patients diagnosed with temporomandibular joint pathology who were reconstructed with a TMJ prosthesis. This prosthesis has four components, two of the articular fossa (one part of titanium and the other part of polyethylene) and two of the body of the device (condylar head of cobalt-chrome and ramus of titanium). Results: We present the preliminary results of the patients reconstructed with a TMJ prosthesis in the past 2 years in our center. A total of 8 prosthesis were place in 6 patients. The diagnosis of the patients was TMJ ankylosis in 4 cases, and severe TMJ dysfunction in the other 2 cases. An improvement of both pain and also mouth opening was observed after a follow-up of at least 6 months. Conclusion: This TMJ prosthesis, developed in Spain, has many advantages, such as the possibility of replacement of some of the parts, as well as its design since the masticatory forces are transmitted to the mandibular ramus and not to the screws of the device.

Study Design: A case report with 2 year follow up. Objective: The aim of this paper is to present a case of bilateral TMJ ankylosis with coexisting dentofacial deformity and occlusal cant, and 2 years follow-up evaluation for changes and relapse in the facial skeletal and airway. Methods: The patient was planned preoperatively by computer simulation for bilateral interposition arthroplasty and surgical jigs, coronoidectomy, detachment of masseter and medial pterygoid muscles from ramus, LeFort 1 osteotomy, temporary maxillomandibular fixation, counter-clockwise rotation of the maxillomandibular complex, maxillary fixation and iliac crest graft, reconstruction of bilateral TMJ with custom-made total joint prosthesis, dermal fat interposition in the joint, reattachment of muscles, maxillomandibular fixation, and active physiotherapy. Results: Average ramal length improved by 28.35 mm (81%) in the immediate postoperative and 25.6 mm (73.45%) at 2 years, showing 2.75 mm (4.4%) vertical bone resorption at the angle region. Point A advanced by 1.3 mm, but showed 4.5% horizontal relapse; Point B advanced by 10.2 mm, but showed 9.5% relapse at 2 years. Pogonion advanced by 26.3 mm (70%) but presented 7 mm (10.9%) horizontal relapse; and menton by 28.6 mm (89%) with 5.4 mm (8.9%) relapse at 2 years. The mean mandibular plane angle decreased by 33.5° (42%) after surgery and by 32° (40%) at 2 years. Pharyngeal airway increased by 49% after surgery and by 75.6% at 2 years follow-up. Conclusion: This computer simulated approach for the management of bilateral TMJ ankylosis with facial deformity and occlusal cant improves aesthetics, function and airway in a single surgery, thereby reducing the management cost and time, and deliver precise results.

We report findings in rare case of a patient with infiltrative lipomatosis presenting as hemifacial hyperplasia with TMJ ankylosis. The unusual presentation of lipomatosis around nerves with bone overgrowth impeded quick diagnosis, leading the authors to conduct a literature review in addition to analysis of clinical, CT, MRI, and pathological findings to eliminate differentials, specifically, the distinction between infiltrative lipomatosis, neurolipomatosis, and hemifacial hyperplasia. The conclusions of the findings confirm the difficultly in pinpointing such a manifestation for hemifacial hyperplasia that presents with lipomatosis.

Many surgical techniques have been described for the treatment of TMJ ankylosis, but no strategy has been uniformly agreed upon underscoring the difficulty of the problem. Despite new guidelines and updated methods, treating patients with TMJ Ankylosis remains a challenge as the incidence of recurrence after treatment is soaring. This study exemplifies our experience in using an unsullied method to treat TMJ Ankylosis to restore the structure of TMJ in conjunction with convalescing secondary maxillofacial deformity.A total of 56 cases of unilateral bony TMJ ankylosis were included in the study, and postoperative results of T.M.J disc as a soft tissue interposition graft was evaluated. The operative protocol comprised of (1) resection of ankylotic mass, (2) intraoral ipsilateral coronoidectomy or contralateral coronoidectomy when needed, (4) interpositioning disc as soft tissue graft, (5) interposing and fixing sternoclavicular or costocondral graft with lag screws and (6) early mobilization, aggressive physiotherapy.The study assessed patients with regular follow-up checks for a period of 3 years. The average preoperative mouth opening was found to be 5.46 mm (range 2-10 mm). Mean post-operative mouth opening was 33.05 mm (range 24-43 mm), while 3 years post operative mouth opening (mean) was 39.75 mm. No cases of reankylosis were reported during this period suggesting it as a viable and satisfactory approach.The use of TMJ disc as a soft tissue interpositional graft material is an effectual method for functional rehabilitation of ankylosis cases and serves as an effective means of preventing recurrence.

Bilateral Temporomandibular Joints ankylosis brings extensive limitations on the patient quality of life. Surgical treatment is frequently necessary associated with a continuous rehabilitation. To avoid iatrogenic injuries and potential complications, anatomy of this region, must be thoroughly known by operating surgeon.

We describe a case of a 17-year-old male who remained drowsy following left temporomandibular joint (TMJ) interposition arthroplasty for TMJ ankylosis. Computed tomography of the head demonstrated an extradural hematoma. The possible cause of this unusual occurrence is discussed.

A anquilose da articulação temporomandibular (ATM) que ocorre após a fratura do côndilo mandibular constitui um desafio de tratamento para os cirurgiões buco-maxilo-faciais. É uma condição na qual existe imobilidade da articulação, caracterizada pela formação de um tecido ósseo, fibroso ou massa fibro-óssea fundida a base do crânio. Traumas, doenças sistêmicas e infecções estão entre os fatores mais comuns que desencadeiam a progressão desta condição. A literatura demonstra diversas maneiras de tratamento como: artroplastia em gap, artroplastia em gap interposicional usando o músculo temporal, reconstrução da ATM utilizando enxerto costocondral e reconstrução aloplástica da articulação. Diante disso, este artigo objetiva relatar o caso de uma criança vítima de trauma (acidente ciclístico), diagnosticada com fratura alta no côndilo mandibular esquerdo e demonstrar a possibilidade de evolução da fratura em anquilose de ATM e, em sequência, evidenciar a eficácia do tratamento cirúrgico realizado por artroplastia em gap associado a fisioterapia como protocolo de sucesso no tratamento de anquilose com 2 anos de acompanhamento. O englobamento dos dados se deu por meio da busca de em periódicos, artigos científicos e trabalhos de conclusão de curso encontrados nos bancos de dados Pubmed, BVS e Capes.

A 2-year-old boy was brought by his parents with complaints of difficulty in mouth opening for the past one and half years. He had difficulty in chewing and was malnourished, with developing facial asymmetry. He was diagnosed with right side temporomandibular joint ankylosis. We planned for surgical removal of the ankylotic mass. But we modified the treatment protocol. Instead of doing coronoidectomy after aggressive excision of the ankylotic mass as advocated by Kaban, we did a ‘coronoidoplasty’ after aggressive excision of the ankylotic mass. Coronoidotomy or coronoidectomy is one of the rungs in the treatment ladder that is followed in surgical management of temporomandibular joint ankylosis. But one of the postoperative complications after coronoidectomy is the open bite. The difficulty to close the mouth becomes more pronounced when bilateral coronoidectomy is done. However, ‘coronoidoplasty’, as we have done for this patient retains the action of the temporalis muscle on the mandible in closing the mouth, yet removes the mechanical interference of the coronoid process. Postoperatively the patient was able to clench his teeth well, chew properly and there was no open bite.

Additive manufacturing or 3-dimensional (3D) printing technology has an incredulous ability to create complex constructs with high exactitude. Surgical guides printed using this technology allows the transfer of the virtual surgical plan to the operating table, optimizing aesthetic outcomes, and functional rehabilitation. A vast variety of materials are currently being used in medical 3D printing, including metals, ceramics, polymers, and composites. The guides fabricated with titanium have high strength, excellent biocompatibility, and are sterilizable but take time to print and are expensive. We have thus followed a hybrid approach to fabricate an inexpensive surgical guide using metal where the advantage of 3D printing technology has been combined with the routinely followed investment casting procedure to fabricate guides using nickel–chromium, which has all the advantages of a metal and is cost-effective.

AIM: The main aim of this study is to compare the gap arthroplasty with interpositional gap arthroplasty for the management of TMJ ankylosis. METHODOLOGY: A prospective randomized multicenter clinical trial had been performed, on 60 patients diagnosed with TMJ ankylosis from August 2005 to June 2015. Patients were equally divided into two groups: Group I patients were treated with gap arthroplasty, while patients in Group II were treated with interpositional arthroplasty. RESULTS: The mean age in Group I was 27.9 years and in Group II was 25.6 years. Trauma was the common etiological factor in both the groups. The mean postoperative mouth opening after 1 month, 6 months and 24 months was found to better in Group II. Open bite after 24 months was present in six patients in Group I and in one case in Group II. Permanent facial nerve palsy was present in one patient in both the groups. Frey’s syndrome was present in one patient from Group I and none from Group II. Reoccurrence occurred in eight cases from Group I (26.6%) and none from Group II. CONCLUSION: This study concluded that interpositional arthroplasty is better than gap arthroplasty in terms of mouth opening and reankylosis.

Temporomandibular joint ankylosis is a major disorder, mainly due to trauma and other reasons, which is responsible for the restriction of mandibular functional activities. The scope of the successful surgical correction of temporomandibular joint ankylosis with amniotic membrane is on the membrane's being an interpositional material which we found not to elicit any host reaction, is capable of functional adaptation, and is very economical. Our purpose is to show the amniotic membrane as a suitable, biocompatible, and interpositional material alternative to the other materials, thereby reducing donor site morbidity.A study was conducted in 13 patients with an age range of 10 to 35 years with unilateral and bilateral bony TMJ ankylosis confirmed by clinical and radiological evaluations. Preoperative and postoperative clinical assessments of TMJ functions were done. Amniotic membranes were collected from the tissue bank, sterilized by gamma radiation, and freeze-dried. Then, the prepared amniotic cap (10-15 layers of amniotic membrane) was placed over the condylar head and anchored loosely to the neck and the surrounding tissues with a 3/0 Vicryl suture.Measurements of postoperative maximum interincisal opening was taken with scale among the 13 patients. Preoperative interincisal distances ranged from 0 to 15 mm, and preoperative and immediate postoperative were 33-45 and 25-32 mm, respectively. Postoperative follow-up of interincisal opening after 1-, 6-, and 12-month intervals was found from 32 to 35 mm. Lateral excursions (left and right), protrusive movements, and functional recovery were all satisfactory.Amniotic membrane graft as an interpositional material in temporomandibular joint ankylosis can be a good alternative as to prevent reankylosis and recover functionality.